Provider Demographics
NPI:1609287705
Name:LATTER, COURTNEY
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:LATTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 ORCHARD ST
Mailing Address - Street 2:APT 5A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-1415
Mailing Address - Country:US
Mailing Address - Phone:818-497-4664
Mailing Address - Fax:
Practice Address - Street 1:191 ORCHARD ST
Practice Address - Street 2:APT 5A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-1415
Practice Address - Country:US
Practice Address - Phone:818-497-4664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NULL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program